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Insider Arthritis Tips January 2015
January 15, 2015

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Life Is Like Riding A Bicycle.  To Keep Your Balance, You Must Keep Moving ~ Albert Einstein

Nonagenarians experience expected rates of postoperative mortality after TKA

Although there is a greater risk for certain complications, total knee arthroplasty can be performed among nonagenarians more safely than previously reported, according to study results in the journal Arthroplasty and reported on Healio.

Through a retrospective review of a total joint replacement registry, researchers identified 216 patients at least 90 years old, 8,150 patients between 80 and 89 years old and 73,424 patients younger than 80 years who underwent primary total knee arthroplasty (TKA).

The researchers found a greater number of comorbidities preoperatively, a higher rate of deep vein thrombosis and 30-day mortality, and a longer length of hospital stay in nonagenarians compared with patients between 80 and 89 years old and younger than 80 years.

Due to higher readmission rates, patients in this age group should undergo close follow-up during a prolonged postoperative period, the researchers concluded.

Comment: More risk but maybe the risk is not as high as once thought.


Cobalt toxicity becoming more prevalent with hip replacement surgery

Kimberly Retzlaff writing for Rheumatology News reported Dr. Robert Bunning from the National Rehabilitation Hospital in Washington, DC presented findings that patients who undergo either metal on metal or metal on polyethylene implants are at risk for cobalt poisoning.

High risk patients include women, patients who are overweight or who are physically very active, bilateral implants, high doses of steroids, patients with borderline kidney function, and patients with a suppressed immune system. Major complications include cardiomyopathy- a severe heart condition, and hypothyroidism.

Comment: Another potential problem related to joint replacement surgery.


Researcher To Study Link Between Blueberries, Bone Health.

The Associated Press reported, “a Purdue University researcher has won a federal grant to study the connection between blueberries and bone health in post-menopausal women.” Earlier this week, “the university announced...that Connie Weaver will receive $3.7 million from the National Institutes of Health to conduct five years of research.” Prior research has “found that nutrients found in blueberries can help reduce bone loss that occurs naturally over time.”

Comment: We know blueberries are beneficial for a number of conditions. And here’s another one.


Home exercise effective after knee replacement

Hugo Wilcken writing in Rheumatology Update reported a monitored home exercise program in the first six weeks after knee replacement surgery has similar outcomes to standard rehabilitation, Sydney researchers report.

Their study looked at nearly 400 knee-replacement patients who were randomised to either a six-week monitored home exercise program or usual care, which generally involved clinic-based outpatient physiotherapy.

There were no significant differences between the two interventions in pain scores, physical function, knee flexion, knee extension or walk time, found the researchers from the Faculty of Health Sciences at the University of Sydney.

Comment: Good news because doing it yourself certainly is more convenient.


Adding Chinese herb to methotrexate may help ease active RA

Lorraine Janeczco writing for Reuters reported patients with active rheumatoid arthritis (RA) may benefit from treatment with Tripterygium wilfordii Hook F (TwHF) and methotrexate (MTX), new research from China suggests.

In fact, the researchers say, TwHF monotherapy works as well as MTX plus TwHF, and better than MTX monotherapy, for controlling active disease.

"While TwHF, a traditional Chinese herb, is still in the FDA Poisonous Plant Database, the extract of TwHF has been widely used for more than 30 years by Chinese rheumatologists, and many patients have been continuously treated with it and followed for years," wrote principal investigator Dr. Xuan Zhang of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, in Beijing, China, in an email to Reuters Health.

"The major toxicities observed in China are gastrointestinal symptoms and reversible amenorrhea, especially in perimenopausal women," Dr. Zhang added.

"TwHF could be a promising approach to the treatment of active rheumatoid arthritis, particularly as not all patients respond to DMARDs (disease-modifying antirheumatic drugs) and modern biologic treatments, and because these drugs are expensive," he suggested.

Comment: This is exciting because of the relatively low cost of this herb.


Patients With Knee OA Often Not Receiving Adequate Pain Relief.

Lucy Piper writing in Medwire News reported according to a study published in the journal Rheumatology, “patients with knee osteoarthritis (OA) requiring analgesic therapy are often not receiving adequate pain relief.” The study, which involved “more than 1000 patients...found that 54% had inadequate pain relief (IPR) after at least two weeks of analgesic treatment, which was associated with large functional loss and impaired quality of life (QoL).”

Comment: The good news is that newer meds are coming down the pike.


Spinal Manipulation Helps Relieve Back-Related Leg Pain

Reported in Healthday, adding spinal manipulative therapy (SMT) to home exercise and advice (HEA) may improve short-term outcomes in patients with subacute and chronic back-related leg pain (BRLP). Gert Bronfort, D.C., Ph.D., of the University of Minnesota in Minneapolis, and colleagues reported their findings in the Annals of Internal Medicine.

Comment: Acute sciatica may be very responsive to spinal manipulation.


Treating insomnia in elderly reduces inflammation, lowers risk for chronic diseases

Mark Wheeler writing for Medical Xpress reported lack of sleep can make you sick. And while everybody has the occasional restless night, for those who suffer from chronic insomnia—some 15 percent of older adults in the United States—that sleep loss can increase the risk for cardiovascular disease, hypertension, weight gain, type 2 diabetes, and even lead to an earlier death.

The reason for the increased risk of health problems is thought to be an association between insomnia and an increase in inflammation throughout the body that becomes chronic. Though inflammation can be a good thing, chronic inflammation can damage and kill healthy cells, leading to disease.

UCLA researchers demonstrated that reducing insomnia can indeed lead to decreases in inflammation, and second, that a form of psychotherapy called cognitive behavioral therapy proved superior to other forms of treatment.

The study appears in the journal Sleep.

The results were obtained from a randomized clinical trial of 123 adults older than 55, and showed that treating insomnia led to decreases in a known marker of inflammation called C-reactive protein (CRP). The protein is found in blood plasma, and its levels rise in response to an acute inflammatory stimulus. The CRP levels were measured at the beginning of the study, again after treatment, and again in a follow-up 16 months later.

Comment: Moral of the story: Get your ZZZZsss.


Hypersensitivity to non-painful events may be part of pathology in fibromyalgia

New research shows that patients with fibromyalgia have hypersensitivity to non-painful events based on images of the patients' brains, which show reduced activation in primary sensory regions and increased activation in sensory integration areas. Findings published in Arthritis & Rheumatology, a journal of the American College of Rheumatology (ACR), suggest that brain abnormalities in response to non-painful sensory stimulation may cause the increased unpleasantness that patients experience in response to daily visual, auditory and tactile stimulation.

Comment: This report adds credence to the theory of central nervous system hyperactivity.


No innocent bystander: cartilage contributes to arthritis

Reported in Health Canal, Melbourne researchers have discovered that cartilage plays an active role in the destruction and remodelling of joints seen in rheumatoid arthritis, rather than being an ‘innocent bystander’ as previously thought.

Dr Tommy Liu and colleagues have discovered cartilage plays an active role in rheumatoid arthritis and is not an 'innocent bystander' as previously thought.

Dr Tommy Liu, Professor Ian Wicks, Dr Kate Lawlor, Dr Ben Croker and colleagues from the Walter and Eliza Hall Institute made the discovery while investigating the role of the protein SOCS3 in controlling inflammation during rheumatoid arthritis. The study was published in the journal Arthritis and Rheumatology.

Comment: While this is the case in rheumatoid disease, I wonder if the same is true in osteoarthritis.

Tips To Relieve Carpal Tunnel Syndrome Pain

By Mayo Clinic Staff

There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists by taking the following precautions:

  • Reduce your force and relax your grip. Most people use more force than needed to perform many manual tasks. If your work involves a cash register, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink. This way you won't have to grip the pen tightly or press as hard on the paper.
  • Take frequent breaks. Give your hands and wrists a break by gently stretching and bending them periodically. Alternate tasks when possible. If you use equipment that vibrates or that requires you to exert a great amount of force, taking breaks is even more important.
  • Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. If you use a keyboard, keep it at elbow height or slightly lower.
  • Improve your posture. Incorrect posture can cause your shoulders to roll forward. When your shoulders are in this position, your neck and shoulder muscles are shortened, compressing nerves in your neck. This can affect your wrists, fingers and hands.
  • Keep your hands warm. You're more likely to develop hand pain and stiffness if you work in a cold environment. If you can't control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.

Sleep on it


A good night’s sleep helps you think more clearly throughout the day.  And it may keep you clear throughout your life.  Healthy people 55 and older who continue to sleep the same number of hours each night as they age stay sharper, a study showed.  When the study began, participants reported how much they slept, then had a brain scan and a cognitive test.  Every two years, they reported on their sleeping habits and had the tests again.  For each one-hour drop in sleep time, those who snoozed less saw a drop in cognitive performance and an increase in brain atrophy compared with their peers who hadn’t cut back on sleep.

Apple Cider Beef Stew Recipe
Prep: 20 min. ~ Cook: 6-1/4 hours ~ Makes: 12 servings

  • 4 Cups of frozen vegetables for stew (about 24 ounces), thawed
  • 1 can (8 ounces) sliced water chestnuts, drained
  • 1 jar (4-1/2 ounces) sliced mushrooms, drained
  • 1 tablespoon dried minced onion
  • 2 envelopes brown gravy mix
  • 2 tablespoons of onion soup mix
  • 2 teaspoons steak seasoning
  • 1/8 teaspoon ground cinnamon
  • 2 pounds beef stew meat, cut into 1-inch cubes
  • 1 can (14-1/2 ounces) beef broth
  • 1 ¼ cups apple cider or unsweetened apple juice
  • 1 can (8 ounces) tomato sauce
  • 1 bay leaf
  • 3 tablespoons cornstarch
  • 1/3 cup cold water


  1. Place the vegetables, water chestnuts, mushrooms and onion in a 5-qt. slow cooker. In a large re-sealable plastic bag, combine the gravy mix, soup mix, steak seasoning and cinnamon; add beef, a few pieces at a time, and shake to coat. Add to slow cooker.
  2. Combine the broth, cider and tomato sauce; pour over beef. Add bay leaf. Cover and cook on low for 6-7 hours or until meat is tender.
  3. Combine cornstarch and water until smooth; stir into stew. Cover and cook on high for 15 minutes or until thickened. Discard bay leaf. Yield: 12 servings.

Tips To Ease A Sore Throat

Amanda MacMillan

These easy, non-prescription remedies can help ease soreness and scratchiness fast. A sore throat can be the first sign of a cold, a side effect of strained vocal cords, or an indication of something more serious (like strep throat).  Here are 10 to try the next time you're feeling scratchy, hoarse, or just plain sick.

  • Anti-inflammatories - One of the most effective treatments for sore throat is an over-the-counter, non-steroidal anti-inflammatory drug (NSAID) such as Advil or Aleve.
  • Saltwater gargle - Several studies have found that gargling several times a day with warm salt water can reduce swelling in the throat and loosen mucus, helping to flush out irritants or bacteria. Doctors generally recommend dissolving half a teaspoon of salt in one cup of water. If the salty taste is too much, try adding a small amount of honey to sweeten the mixture slightly. (Just remember to spit the water out after gargling!)
  • Lozenges and sprays - Sucking on cough drops stimulates saliva production, which can help keep your throat moist. But many varieties are no more effective than hard candies. Choose brands with a cooling or numbing ingredient, like menthol or eucalyptus.
  • Cough syrup - Even if you don't have a cough (yet), over-the-counter cough syrups can help ease soreness. Like drops and sprays, they coat the throat and provide temporary pain relief.
  • Fluids - Staying hydrated is very important, especially when you're sick and your throat is irritated or inflamed. You should be drinking enough fluid so that your urine is light yellow or clear.
  • Tea - A warm cup of herbal tea can offer immediate, soothing relief for a sore throat. What's more, non-herbal teas—contain antioxidants that are thought to strengthen immunity and ward off infection.
  • Chicken soup - An age-old home remedy for colds, chicken soup can help soothe a sore throat, as well. The sodium in the broth may actually have anti-inflammatory properties, and it can feel good going down.
  • Marshmallows - Although there's no hard evidence that it works, sap from the marshmallow plant has been used for hundreds of years—usually in tea form—to treat coughs, colds, and sore throats.
  • Rest - It may not be the quickest solution, but getting some rest is probably the best thing you can do to battle the infection that caused your sore throat in the first place.
  • Antibiotics - Every once and a while—about 10% of the time in adults—a sore throat will be caused by a bacterial infection such as Streptococcus pyogenes. If you test positive for strep throat or another bacterial infection, your doctor should prescribe an antibiotic. Always take the full course of medicine, even if you feel better after a few days.

Did you know that Carpal Tunnel Syndrome (CTS) can affect anyone?

None of us are immune to developing CTS as roughly 1 out of 20 of us will develop CTS in our lifetime!

  1. Race: Caucasians carry the greatest risk of developing CTS.
  2. Gender: Women are three times more likely than men to develop CTS. This may be because female wrists are smaller and shaped a little differently than male wrists, but hormonal differences are probably the most important reason for this variance.
  3. Pregnancy: Up to 62% of pregnant women develop CTS. This is thought to be due to the excess fluid retention that normally occurs during pregnancy and most likely stems from the elevation in hormone levels that NORMALLY occurs during pregnancy.
  4. Birth Control Pill (BCP): The use of BCPs increases CTS risk due to an increase in hormonal levels similar to the CTS risk increase during pregnancy.
  5. Occupational: Workers in highly repetitive, hand-intensive occupations (such as line work, sewing, meat processing, cashiers) have a higher rate of developing CTS.
  6. Injury to the wrist or hand: An obvious example is a wrist fracture from a slip and fall, sports injury, or blunt trauma like a car accident. When there is a direct pinch on the median nerve, nerve damage can occur quite quickly, and the onset of symptoms can be very fast.
  7. Certain conditions: Nerve damaging conditions that can cause CTS include diabetes and alcoholism. Other conditions may include: menopause, obesity, thyroid disorders, kidney failure, and more.
  8. Inflammatory conditions: These include several types of arthritis such as rheumatoid and lupus.
  9. Faulty work stations: A job site has A LOT to do with whether or not a person develops CTS. Though jobs that require fast, repetitive movements pose the greatest risk. Poor posture in the back, neck, and the rest of the body can contribute to CTS.

Wei's World, January 2015

Wei’s World


Almost every year, I attend the national meeting of the American College of Rheumatology.  Usually I have a presentation or have collaborated with someone who has a presentation.  But I also use the time at ACR to network with people, sponsors, and other entities that might help with the practice.

Much of what is presented is already known to me.  I don’t say that to brag but because we do so much research, the results of the clinical trials we participated in are relatively old news. I do like to attend the poster sessions, however, because it gives me a chance to talk directly with each presenter.  And, this year, it seemed like there were also many interesting talks being given as well.

Often I see people whom I haven’t seen in many years.  Other times I meet new people who are eager to learn about what we’re doing at our center.

This year’s meeting was in Boston.  I had the pleasure of having lunch with my old mentor, Dr. Paul Plotz, from my training at the National Institutes of Health.  Dr Plotz is a legend in the field of rheumatology and one of the most erudite people I know.  We talked a long time about life in general, our families, the work we’re doing, what other colleagues are doing, and so on.  It was such a pleasure to see him.

Also, two of our children live in Boston so, of course, my wife and I took significant time out to be with them.  Now that they are adults, it is whole new type of relationship than it was when they were still at home. We had several dinners and a brunch with them and it was quite enjoyable.

The convention center in Boston, like the ones in many cities is enormous.  Walking around is tiring.  Comfortable shoes help but still…

And the number of attendees is staggering.  Roughly 10,000 people were at this year’s meeting.  Also, there were more people attending from outside the U.S. than from in the US.   When I first started attending ACR in 1979, it was held in a single hotel!

November in Boston can be dicey weather-wise.  This year the meeting was held during a cold snap.  And the wind made being outdoors very uncomfortable. Which leads me to the next topic…

While the usual mode of getting around at the meeting is by taxi, my wife and I discovered Uber.  This is a service that works like a taxi but you summon a car, driven by a “civilian”, using an app on your phone.  The wait is usually quite short and the fees are about two-thirds of what a cab would cost.  It was an interesting experience.

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